Emergency Evacuation Feedback Form

Thank You for choosing AMREF Flying Doctors, we hope we provided you with the level of care you expected in your time of need. Whether you want to tell us about exemplary care, or something which you feel could have been done differently, all feedback is important to us and helps us to continually improve our service. AMREF Flying Doctors has been in the aeromedical industry for over 60 years and we are constantly updating and improving our service. This feedback survey should take no more than 10 minutes. We really appreciate you taking the time to fill this out for us.

How do you rate *

	1. Poor	2. Below Average	3. Satisfactory	4. Good	5. Excellent
The process of requesting an air ambulance or ground evacuation with AMREF Flying Doctors	The process of requesting an air ambulance or ground evacuation with AMREF Flying Doctors 1. Poor	The process of requesting an air ambulance or ground evacuation with AMREF Flying Doctors 2. Below Average	The process of requesting an air ambulance or ground evacuation with AMREF Flying Doctors 3. Satisfactory	The process of requesting an air ambulance or ground evacuation with AMREF Flying Doctors 4. Good	The process of requesting an air ambulance or ground evacuation with AMREF Flying Doctors 5. Excellent
The response time of AMREF Flying Doctors	The response time of AMREF Flying Doctors 1. Poor	The response time of AMREF Flying Doctors 2. Below Average	The response time of AMREF Flying Doctors 3. Satisfactory	The response time of AMREF Flying Doctors 4. Good	The response time of AMREF Flying Doctors 5. Excellent
The clinical care you received while in transit	The clinical care you received while in transit 1. Poor	The clinical care you received while in transit 2. Below Average	The clinical care you received while in transit 3. Satisfactory	The clinical care you received while in transit 4. Good	The clinical care you received while in transit 5. Excellent
Aircraft or ground ambulance cleanliness and quality of equipment on board	Aircraft or ground ambulance cleanliness and quality of equipment on board 1. Poor	Aircraft or ground ambulance cleanliness and quality of equipment on board 2. Below Average	Aircraft or ground ambulance cleanliness and quality of equipment on board 3. Satisfactory	Aircraft or ground ambulance cleanliness and quality of equipment on board 4. Good	Aircraft or ground ambulance cleanliness and quality of equipment on board 5. Excellent
Medical staff professional conduct, knowledge and communication during the evacuation process	Medical staff professional conduct, knowledge and communication during the evacuation process 1. Poor	Medical staff professional conduct, knowledge and communication during the evacuation process 2. Below Average	Medical staff professional conduct, knowledge and communication during the evacuation process 3. Satisfactory	Medical staff professional conduct, knowledge and communication during the evacuation process 4. Good	Medical staff professional conduct, knowledge and communication during the evacuation process 5. Excellent
The overall service you received	The overall service you received 1. Poor	The overall service you received 2. Below Average	The overall service you received 3. Satisfactory	The overall service you received 4. Good	The overall service you received 5. Excellent

Was the transport in an AMREF Flying Doctors ambulance or by a partner service? *

	AMREF Flying Doctors	Partner Service
	AMREF Flying Doctors	Partner Service

Would you recommend AMREF Flying Doctors services to a friend or relatives? * (copy) *

	Yes	No
	Yes	No

Comments, compliments, suggested improvements or complaints: *

Name *

First

Last

Email *

By Submitting this form you agree to the Privacy Policy of AMREF Flying Doctors. This information may be used internally to improve our services. Your suggestions for improvement will be kept private. If you do not agree this, please do not use this form.

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Emergency Evacuation Feedback Form

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